Male slings for postprostatectomy urinary incontinence

ABSTRACT

Incontinence after prostatectomy for benign or malignant disease is a well-known and often feared outcome. The objective of this study was to evaluate the role of bulbourethral slings in the treatment of post prostatectomy incontinence, as being a fast, less expensive and reliable method in comparison to other modalities. This study was conducted on 40 patients in the period from May 2003 till October 2005 [median 12 months], who have underwent prostatectomy, and have established total or severe stress incontinence after a period of at least 6 months postoperatively. All patients included in the study were subjected to full history taking, physical examination, laboratory preoperative investigations, radiological study in the form of ascending urethrocystography, micturating films, and Urodynamic study including uroflowmetry, filling cystometry and pressure flow study, urethral pressure profile and estimation of the abdominal leak point pressure. EMG was done for all patients. Uretherocystoscopy was used to exclude anastomotic or urethral stricture. All patients underwent sling operation and were divided into two groups. In Group 1 Slings were applied by a perineal approach and in Group 2 Slings were applied by a combined abdomino-perineal approach using synthetic material or rectus sheath Exclusion criteria included; urethral strictures, vesical causes including atonic bladder causing urinary retention with overflow, or overactive bladder due to either a neurogenic cause or infection leading to bladder irritability and uninhibited bladder contractions. A total of 40 patients 50 to 78 years old [median 68 years] underwent male sling placement. The mean operative time was 45 minutes without confrontation with intraoperative complications. Postoperative complication rate was 42.5%. This rate can be further divided according to the fate of complications into permanent [irreversible] being about 5% of the total complications and 37.5% of the total complication being temporary [reversible]. The total cure rate in the study was an average of 67.5.% and the total improvement rate was an average of 12.5%, giving a mean cure/ improvement value of 80%. The overall failure rate was 20% of patients involved. The male bulbourethral sling is a quick, safe, simple and effective option in the treatment of postprostatectomy incontinence, and considered to be an alternative to other methods such as artificial urinary sphincter, periurethral injection. Yet longer follow up and further experience will be needed to establish its long-term efficacy